Clinical transplantation of a tissue-engineered airway

Scientists achieve a milestone in medicine using stem cell culture, heralding a new age in surgical care that can offer transplants free from the fear of rejection.

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Claudia Castillo, a 30-year old mother of two, suffered from a severe lung collapse caused by long-term tuberculosis. She was left unable to carry out simple tasks or care for her two children. The only possible conventional treatment was to remove one of her lungs, a risky procedure with a high mortality rate that would at best have dramatically impaired her quality of life. Doctors tend not to recommend trachea transplants because the windpipe is one of the body’s organs most prone to rejection. But the patient was young and suffering from a rare kind of tracheal damage, so special permission was granted for an experimental treatment performed by a team of scientists from the University of Barcelona, Britain's University of Bristol, and, in Italy, the University of Padua and Milan's Polytechnic.

The procedure was reported in the November 19th 2008 issue of Lancet.

Photo courtesy of the Hospital Clinic of Barcelona

A windpipe from a deceased donor was enzymatically stripped of all MHC antigens as well as epithelial, glandular and chondrocyte cells to serve as the tracheal scaffold. Epithelial cells were taken from Claudia’s right bronchus to grow epithelial cells and stem cells were isolated from the patient's bone marrow and induced to differentiate into chondrocytes. Life Technology’s Gibco® cell culture products were used throughout the procedure, including DMEM, GlutaMAX™ – I supplement, Keratinocyte-SFM and trypsin EDTA. The cultured cells were seeded onto the tracheal matrix, housed within a bioreactor, and within 24 hours the cells had become deeply embedded within the matrix. After four days in the bioreactor, the tissue engineered airway was transplanted into the patient, replacing the damaged left bronchus.

Claudia was discharged just 10 days after the operation. Four months later, the grafted airway was seamlessly integrated into the surrounding tissues and had a normal appearance and mechanical properties, as well as functioning vasculature. The doctors said Claudia is now able to care for her children and enjoy a normal quality of life. She can walk up two flights of stairs and occasionally even go out dancing at night.

The procedure's success opens up a world of possibilities for "personalized" transplants that use the recipient's adult stem cells and, as a result, require no immunosuppressive therapy and risks no transplant rejection.

"Surgeons can now start to see and understand the very real potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases," said Martin Birchall, professor of surgery at the University of Bristol and part of the team that did the operation.

"We believe this success has proved that we are on the verge of a new age in surgical care."

"It's a very important demonstration that if different branches of science put together their forces, they can help people," says Professor Paolo Macchiarini, principle author of the study and head of thoracic surgery at Hospital Clinic of Barcelona, where the surgery was performed.

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Life Technologies Corporation is committed to the advancement of stem cell research and is the leading global supplier of cell culture research products and services. To find out more about Life Technologies stem cell products go to www.invitrogen.com/stemcell and to find more about the Gibco® cell culture products used in this study go to www.invitrogen.com/cellculture.